title: Establishing a successful coronary CT angiography program in the emergency department: official writing of the Fellow and Resident Leaders of the Society of Cardiovascular Computed Tomography (FiRST).
abstract: Coronary CT angiography is an effective, evidence-based strategy for evaluating acute chest pain in the emergency department for patients at low-to-intermediate risk of acute coronary syndrome. Recent multicenter trials have reported that coronary CT angiography is safe, reduces time to diagnosis, facilitates discharge, and may lower overall cost compared with routine care. Herein, we provide a 10-step approach for establishing a successful coronary CT angiography program in the emergency department. The importance of strategic planning and multidisciplinary collaboration is emphasized. Patient selection and preparation guidelines for coronary CT angiography are reviewed with straightforward protocols that can be adapted and modified to clinical sites, depending on available cardiac imaging capabilities. Technical parameters and patient-specific modifications are also highlighted to maximize the likelihood of diagnostic quality examinations. Practical suggestions for quality control, process monitoring, and standardized reporting are reviewed. Finally, the role of a "triple rule-out" protocol is featured in the context of acute chest pain evaluation in the emergency department.
authors.affiliation: Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8896, USA. christopher.maroules@phhs.org
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Maroules
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Blaha
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: El-Haddad
authors.forename: Maros
authors.initials: M
authors.lastname: Ferencik
authors.forename: Ricardo C
authors.initials: RC
authors.lastname: Cury
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging*; D002637:Chest Pain / Q000000981:diagnostic imaging*; D017023:Coronary Angiography / Q000379:methods*; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006801:Humans; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D016730:Program Development; D011786:Quality Control; D018570:Risk Assessment; D012955:Societies, Medical; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: Acute chest pain triage; Coronary CT angiography